Acknowledgments: The author thanks all of the patients seen at The Lyme Disease Center for helping to teach us about Lyme disease and that which has been misdiagnosed as Lyme disease; the housestaff and rheumatology fellows of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, who have been of such great assistance in the care of these patients; the Clinic staff for their service to the patients; and the Division of Rheumatology staff for making all of this care and work possible.

Grant Support: By the Morris L. Sigal Medical Research Foundation; Arthritis Foundation, New Jersey Chapter; and the University of Medicine and Dentistry of New Jersey Foundation.

Nomenclature influences perceptions of reality and frames ensuing discussions. Imprecision contributes to misinterpretation of observations and studies, altering clinicians' approaches. The impact of imprecision and novel reinterpretation of terminology can be seen in the Lyme disease debate. A quarter century after its initial description, a review of the terminology contributing to confusion about Lyme disease is needed.

Lyme disease is treatable and curable with antibiotics (1-4), especially if treated promptly, usually with an excellent long-term prognosis. The term “promptly” taken out of context suggests one must treat without any delay. In fact, even untreated patients have a good prognosis. A 10- to 20-year follow-up of patients at Yale's Lyme Disease Clinic from 1976 to 1983, many of whom were not treated for early Lyme disease, shows that the patients with erythema migrans did not differ from normal controls in current symptoms, physical findings, results of neuropsychological testing, or responses to the Short-Form 36 Health Assessment Questionnaire (5). However, significant long-term sequelae occurred in patients with untreated facial palsy who probably had disseminated Lyme disease at initial evaluation and probably required intravenous therapy (5).